HomeMy WebLinkAboutX2022-1035 - Permit Application0-:12
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK 1/(7b I 4 W AfVU )
SWIMMING POOL L2' D&V" SPA
Check Appropriate box for
_ ESTIMATED $ VALUATION
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME LAST FIRST
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ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
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PHONE NO.
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4. ENGINEER' NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
❑ 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
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No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS16
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CITY U STATE ZIP
PHONE NO.
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:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $ l
Forms\Pool spa appl (rev3-04).x1s
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